EP2008657B1 - Use of rapamycin derivatives in vasculopathies - Google Patents

Use of rapamycin derivatives in vasculopathies Download PDF

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Publication number
EP2008657B1
EP2008657B1 EP08017336.2A EP08017336A EP2008657B1 EP 2008657 B1 EP2008657 B1 EP 2008657B1 EP 08017336 A EP08017336 A EP 08017336A EP 2008657 B1 EP2008657 B1 EP 2008657B1
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EP
European Patent Office
Prior art keywords
rapamycin
rejection
compound
animals
transplantation
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP08017336.2A
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German (de)
English (en)
French (fr)
Other versions
EP2008657A3 (en
EP2008657A2 (en
Inventor
Walter Schuler
Johannes Schuurmann Hessel
Gisbert Weckbecker
Hans-Günter Zerwes
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Novartis Pharma GmbH
Novartis AG
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Novartis Pharma GmbH
Novartis AG
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Application filed by Novartis Pharma GmbH, Novartis AG filed Critical Novartis Pharma GmbH
Priority to SI9730801T priority Critical patent/SI2008657T1/sl
Publication of EP2008657A2 publication Critical patent/EP2008657A2/en
Publication of EP2008657A3 publication Critical patent/EP2008657A3/en
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Publication of EP2008657B1 publication Critical patent/EP2008657B1/en
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
    • A61K31/436—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a six-membered ring having oxygen as a ring hetero atom, e.g. rapamycin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/02—Immunomodulators
    • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/02—Antithrombotic agents; Anticoagulants; Platelet aggregation inhibitors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis

Definitions

  • the present invention relates to a new use, in particular a new use for a compound which is a derivative of rapamycin, in free form or in pharmaceutically acceptable salt or complex form.
  • Derivatives of rapamycin include e.g. compounds of formula I wherein
  • R 1 or R 2 is preferably R a CO- wherein R a is C 1-6 alkyl.
  • R a is C 1-6 alkyl.
  • Suitable heteroaryl include e.g. pyridyl, morpholmo. piperazinyl and imidazolyl.
  • Examples of such compounds include:
  • the compound for use according to the present invention is 40-O-(2-hydroxy)ethyl-rapamycin (referred thereafter as Compound A).
  • Compounds of formula I have, on the basis of observed activity, e.g. binding to macrophilin-12 (also known as FK-506 binding protein or FKBP-12), e.g. as described in WO 94/09010 , been found to be useful e.g. as immunosuppressants, e.g. in the treatment of acute allograft rejection.
  • macrophilin-12 also known as FK-506 binding protein or FKBP-12
  • EP-A-0 551 182 similarly relates to the use of rapamycin in the treatment of hyperproliferative vascular diseases such as restenosis.
  • EP-A-0 691 130 relates to the use of rapamycin in the prevention of intimal smooth musclecell proliferation, restenosis and/or vascular occlusion following vascular injury.
  • Organ transplants of liver, kidney, lung and heart are now regularly performed as treatment for endstage organ disease. Because of the current shortage of human donors for transplantable allografts, attention has focused on the possibility of using xenografts (transplants between species) in transplantation. One of the major obstacles in transplanting successfully xenografts in humans is immunological.
  • a further obstacle in allo- and xenotransplantation is the chronic rejection and thus organ transplantation is not yet a clinically viable solution to irreversible organ disease.
  • Chronic rejection which manifests as progressive and irreversible graft dysfunction, is the leading cause of organ transplant loss, in some cases already after the first postoperative year.
  • the clinical problem of chronic rejection is clear from transplantation survival times; about half of kidney allografts are lost within 5 years after transplantation, and a similar value is observed in patients with heart allografts.
  • Chronic rejection is considered as a multifactorial process in which not only the immune reaction towards the graft but also the response of the blood vessel walls in the grafted organ to injury (“response-to-injury" reaction) plays a role.
  • the variant of chronic rejection with the worst prognosis is an arteriosclerosis-like alteration, also called transplant vasculopathy, graft vessel disease, graft arteriosclerosis, transplant coronary disease, etc.
  • This vascular lesion is characterized by migration and proliferation of smooth muscle cells, probably under influence of growth factors that are amongst others synthesized by endothelial cells. This leads to intimal proliferation and thickening, smooth muscle cell hypertrophy repair, and finally to gradual luminal obliteration (vascular remodelling). It appears to progress also through repetitive endothelial injury induced amongst others by host antibody or antigen-antibody complexes; also so-called non-immunological factors like hypertension, hyperlipidemia, hypercholesterolemia etc. play a role
  • Chronic rejection appears to be inexorable and uncontrollable because there is no known effective treatment or prevention modality. Thus, there continues to exist a need for a treatment effective in preventing, controlling or reversing manifestations of chronic graft vessel diseases.
  • RT1 a male DA
  • RT1 1 male Lewis
  • All animals are treated with cyclosporine A at 7.5 mg/kg/day per os for 14 days starting on the day of transplantation, to prevent acute cellular rejection. Contralateral nephrectomy is not performed.
  • Each experimental group treated with a distinct dose of a compound of formula I or placebo comprises six animals.
  • the recipient animals are treated per os for another 69-72 days with a compound of formula I or receive placebo.
  • animals are subjected to graft assessment by magnetic resonance imaging (MRI) with perfusion measurement of the kidneys (with comparison of the grafted kidney and the own contralateral kidney). This is repeated at days 53-64 after transplantation and at the end of the experiment.
  • the animals are then autopsied.
  • Rejection parameters such as MRI score, relative perfusion rate of the grafted kidney and hinologic score of the kidney allograft for cellular rejection and vessel changes are determined and statistically analyzed.
  • Administration of a compound of formula I e.g.
  • Compound A at a dose of 0.5 to 2.5 mg/kg in this rat kidney allograft model yields a reduction in all above mentioned rejection parameters.
  • animals treated per os with 2.5 mg/kg/day of Compound A have a significantly lower MRI score of rejection, histologic score for cellular rejection and vessel changes and a significantly lower reduction in perfusion rate assessed by MRI than the animals of the placebo group.
  • an allogeneic response to the graft does not destroy the graft, but it evokes pathological changes resembling those of chronic rejection in clinical transplantation. These include infiltration into the adventitia of mononuclear cells (lymphocytes, macrophages, some plasma cells), and thickening of the intima.
  • Donor aorta between the branch of the renal artery and the start of the caudal mesenteric aorta is harvested from a male DA (RT1 a ) rat and transplanted orthotopically in a male Lewis (RT1 1 ) rat. Weekly after transplantation, the body weight is recorded.
  • the graft with part of the aorta of the recipient just above and below the transplant is removed. It is perfused ex vivo with phosphatebuffered saline supplemented with 2% paraformaldehyde and 2.5% glutaraldehyde for about 2 minutes, then for 24 hours fixed by immersion fixation in the same solution, and thereafter fixed in 4% buffered formalin.
  • Pieces of the graft are embedded in paraffin, in such a way that both a transversal section and a longitudinal section is made of the grafted aorta and the recipient's own aorta.
  • Sections of 4 ⁇ m thickness are stained by hematoxylin-eosin, elastica-von-Gieson and periodic-acid-Schiff. Apart from conventional light microscopy, images are recorded by confocat laser scanning microscopy. From each section, four areas are scanned, and from each area the thickness of the intima and intima+media is measured at five locations.
  • weight and histology is performed for thymus, spleen, liver, kidney, testes and seminal vesicles.
  • a first experiment includes 4 groups, each comprising 4 animals.
  • isogeneic transplantations (Lewis to Lewis) are performed, and animals receive a placebo microemulsion: the other groups comprise allogeneic transplantations, and animals receive per os either placebo microemulsion or a compound of formula I in microemulsion at 2.5 mg/kg/day.
  • the experiment is terminated at 7 weeks after transplantation.
  • a second experiment includes 4 groups, each comprising 4 animals. In all cases allogeneic transplants are performed, and animals receive per os either placebo microemulsion or a compound of formula I in microemulsion at 0.63, 1.25, 2.5 or 5.0 mg/kg/day. The experiment is terminated 11 weeks after transplantation.
  • Balloon catheterization is performed on day 0, essentially as described by Powell et al. (1989). Under Isofluorane anaesthesia, a Fogarty 2F catheter is introduced into the left common carotid artery via the external carotid and inflated (distension ⁇ 10 ⁇ l H2O). The inflated balloon is withdrawn along the length of the common carotid three times, the latter two times whilst twisting gently to obtain a uniform de-endothelialization. The cathether is then removed, a ligature placed around the external carotid to prevent bleeding and the animals allowed to recover.
  • the compound to be tested is administered p.o. (gavage) starting 3 days before balloon injury (day -3) until the end of the study, 14 days after balloon injury (day +14). Rats are kept in individual cages and allowed food and water ad libidum.
  • the rats are then anaesthetized with Isofluorane, a perfusion catheter inserted through the left ventricle and secured in the aortic arch, and an aspiration cannula inserted into the right ventricle.
  • Animals are perfused under a perfusion pressure of 150 mmHg, firstly for 1 min. with 0.1 M phosphate buffered saline solution (PBS, pH 7.4) and then for 15 min. with 2.5 % glutaraldehyde in phosphate buffer (pH 7.4).
  • the perfusion pressure is 150 mmHg at the tip of the cannula ( ⁇ 100 mmHg in the carotid artery), as determined in a preliminary experiment by introducing a cannula attached to a pressure transducer into the external carotid).
  • Carotid arteries are then excised, separated from surrounding tissue and immersed in 0.1 M cacodylate buffer (pH 7.4) containing 7 % saccharose and incubated overnight at 4° C. The following day the carotids are immersed and shaken for 1h at room temperature in 0.05 % KMn04 in 0.1 M cacodylate. The tissues are then dehydrated in a graded ethanol series. 2 x 10 min in 75%.
  • Sections 1-2 ⁇ m thick are cut from the middle section of each carotid with a hard metal knife on a rotary microtome and stained for 2 min with Giemsa stain. About 5 sections from each carotid are thus prepared and the cross-sectional area of the media, neointima and the lumen morphometrically evaluated by means of an image analysis system (MCID, Toronto, Canada).
  • the compounds of formula I inhibit myointimal proliferation when administered per os at a daily dose of from 0.5 to 2.5 mg/kg. Intimal thickening is significantly less in the vessels of the rats that receive Compound A compared to the control animals, e.g. at 0.5 mg/kg statistical inhibition of neointima formation of 50 %. at 2.5 mg/kg significant inhibition of 75 %.
  • the hamster-into-rat xenograft combination is a so-called difficult concordant combination. Rats do not have natural anti-hamster antibody in sufficient amounts to yield immediate hyperacute rejection as observed in concordant combinations; however, rejection in untreated recipients occurs within 3-4 days, by antibodies in combination with complement. This is visualized in histology by destruction of blood vessels, exsudation and extravasation of erythrocytes, and influx by polymorphonuclear granulocytes; often there are signs of hemorrhage and thrombosis. Once this rejection has been overcome by effective inhibition of antibody synthesis or complement inactivation, a cellular rejection can emerge later on.
  • the heart of a Syrian hamster is heterotopically transplanted in the abdomen of a male Lewis (RTI') rat with anastomoses between the donor and recipient's aorta and the donor right pulmonary artery to the recipient's inferior vena cava.
  • the graft is monitored daily by palpation of the abdomen. Rejection is concluded in case of Cessation of heart beat. Animals are weighed weekly. In the present series of experiments. the endpoint is set to 28 days. Animals are subjected to autopsy; apart from the graft, weight and histology is assessed for thymus, spleen, liver, seminal vesicles and testes. Blood is taken and processed to serum for the determination of cytolytic anti-hamster erythrocyte antibody and hemolytic complement activity.
  • daily dosages required in practicing the method of the present invention will vary depending upon, for example, the compound of formula I employed, the host, the mode of administration and the severity of the condition to be treated.
  • a preferred daily dosage range is about from 0.25 to 25 mg as a single dose or in divided doses.
  • Suitable daily dosages for patients are on the order of from e.g. 0.2 to 25 mg p.o. preferably 5 to 25.
  • the compounds of formula I may be administered by any conventional route, in particular enterally, e.g. orally, e.g. in the form of tablets, capsules, drink solutions, nasally, pulmonary (by inhalation) or parenterally, e.g. in the form of injectable solutions or suspensions.
  • Suitable unit dosage forms for oral administration comprise from ca. 0.05 to 12.5 mg, usually 1 to 10 mg active ingredient, e.g. Compound A, together with one or more pharmaceutically acceptable diluents or carriers therefor.
  • Compound A is well tolerated at dosages required for use in accordance with the present invention.
  • the NTEL for Compound A in a 4-week toxicity study is 0.5 mg/kg/day in rats and 1.5 mg/kg/day in monkeys.

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  • Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Engineering & Computer Science (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Organic Chemistry (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Chemical & Material Sciences (AREA)
  • Epidemiology (AREA)
  • Immunology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Transplantation (AREA)
  • Diabetes (AREA)
  • Hematology (AREA)
  • Vascular Medicine (AREA)
  • Urology & Nephrology (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Nitrogen And Oxygen Or Sulfur-Condensed Heterocyclic Ring Systems (AREA)
  • Medicines Containing Antibodies Or Antigens For Use As Internal Diagnostic Agents (AREA)
  • Saccharide Compounds (AREA)
  • Organic Low-Molecular-Weight Compounds And Preparation Thereof (AREA)
  • Polysaccharides And Polysaccharide Derivatives (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
EP08017336.2A 1996-03-27 1997-03-26 Use of rapamycin derivatives in vasculopathies Expired - Lifetime EP2008657B1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
SI9730801T SI2008657T1 (sl) 1996-03-27 1997-03-26 Uporaba rapamicinskih derivatov pri vaskulopatijah

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
GBGB9606452.2A GB9606452D0 (en) 1996-03-27 1996-03-27 Organic compounds
EP01116262A EP1149581A3 (en) 1996-03-27 1997-03-26 Use of rapamycin derivatives in vasculopathies and xenotransplantation
EP97915441A EP0893996B1 (en) 1996-03-27 1997-03-26 Use of a rapamycin derivative in vasculopathies and xenotransplantation

Related Parent Applications (3)

Application Number Title Priority Date Filing Date
EP01116262A Division EP1149581A3 (en) 1996-03-27 1997-03-26 Use of rapamycin derivatives in vasculopathies and xenotransplantation
EP97915441.6 Division 1997-10-02
EP01116262.5 Division 2001-07-05

Publications (3)

Publication Number Publication Date
EP2008657A2 EP2008657A2 (en) 2008-12-31
EP2008657A3 EP2008657A3 (en) 2009-02-04
EP2008657B1 true EP2008657B1 (en) 2013-04-24

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ID=10791127

Family Applications (3)

Application Number Title Priority Date Filing Date
EP08017336.2A Expired - Lifetime EP2008657B1 (en) 1996-03-27 1997-03-26 Use of rapamycin derivatives in vasculopathies
EP01116262A Withdrawn EP1149581A3 (en) 1996-03-27 1997-03-26 Use of rapamycin derivatives in vasculopathies and xenotransplantation
EP97915441A Revoked EP0893996B1 (en) 1996-03-27 1997-03-26 Use of a rapamycin derivative in vasculopathies and xenotransplantation

Family Applications After (2)

Application Number Title Priority Date Filing Date
EP01116262A Withdrawn EP1149581A3 (en) 1996-03-27 1997-03-26 Use of rapamycin derivatives in vasculopathies and xenotransplantation
EP97915441A Revoked EP0893996B1 (en) 1996-03-27 1997-03-26 Use of a rapamycin derivative in vasculopathies and xenotransplantation

Country Status (30)

Country Link
US (5) US6384046B1 (no)
EP (3) EP2008657B1 (no)
JP (2) JP2000507226A (no)
KR (2) KR20070083654A (no)
CN (1) CN1124135C (no)
AT (1) ATE224194T1 (no)
AU (1) AU716514B2 (no)
BR (1) BR9708358A (no)
CA (1) CA2247275C (no)
CY (1) CY2404B1 (no)
CZ (1) CZ292483B6 (no)
DE (1) DE69715611T2 (no)
DK (2) DK2008657T3 (no)
ES (2) ES2184078T3 (no)
GB (1) GB9606452D0 (no)
HK (1) HK1018688A1 (no)
HU (1) HU226422B1 (no)
ID (1) ID17195A (no)
IL (1) IL125812A (no)
MY (1) MY117798A (no)
NO (1) NO316667B1 (no)
NZ (1) NZ331463A (no)
PL (1) PL187732B1 (no)
PT (2) PT2008657E (no)
RU (1) RU2214247C2 (no)
SI (1) SI2008657T1 (no)
SK (1) SK284343B6 (no)
TR (1) TR199801919T2 (no)
WO (1) WO1997035575A1 (no)
ZA (1) ZA972719B (no)

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PT893996E (pt) 2002-12-31
ATE224194T1 (de) 2002-10-15
EP1149581A2 (en) 2001-10-31
AU716514B2 (en) 2000-02-24
CN1214631A (zh) 1999-04-21
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JP2000507226A (ja) 2000-06-13
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ID17195A (id) 1997-12-11
DE69715611D1 (de) 2002-10-24
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US20140187574A1 (en) 2014-07-03
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US20120177690A1 (en) 2012-07-12
US6384046B1 (en) 2002-05-07
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US20100152105A1 (en) 2010-06-17
CZ307098A3 (cs) 1999-01-13
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GB9606452D0 (en) 1996-06-05
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